Cirrhosis: Difference between revisions
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==Background== | |||
A generally irreversible fibrotic scaring of the liver parenchyma resulting in liver failure | *A generally irreversible fibrotic scaring of the liver parenchyma resulting in liver failure | ||
*The twelfth leading cause of death in men and women in 2013.<ref>Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.</ref> | |||
==Clinical Features== | |||
'''[http://www.mdcalc.com/child-pugh-score-for-cirrhosis-mortality/ <ref>Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64</ref>]''' | '''[http://www.mdcalc.com/child-pugh-score-for-cirrhosis-mortality/ <ref>Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64</ref>]''' | ||
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===Management | ==Differential== | ||
*[[Hepatitis]] chronic B and C | |||
*Alcoholic liver disease | |||
*Non-alcoholic steatohepatitis | |||
*Drug induced (ie. [[Tylenol]]. [[amiodarone]], NRTIs]) | |||
*[[Congestive heart failure (CHF)|Cardiac Cirrhosis]] | |||
*Primary biliary cirrhosis | |||
*[[Primary sclerosing cholangitis]] | |||
*Autoimmune Hepatitis | |||
*Alpha1 anti-trypsin Deficiency | |||
*Cystic Fibrosis | |||
==Management== | |||
'''Complications of cirrhosis''' | '''Complications of cirrhosis''' | ||
* [[Ascites]] | *[[Ascites]] | ||
* Esophageal varices | *Esophageal varices | ||
* [[Hepatic encephalopathy]] | *[[Hepatic encephalopathy]] | ||
* [[Spontaneous bacterial peritonitis]] | *[[Spontaneous bacterial peritonitis]] | ||
* [[Hepatorenal syndrome]] | *[[Hepatorenal syndrome]] | ||
* Portal hypertension | *Portal hypertension | ||
* Hepatocellular carcinoma | *Hepatocellular carcinoma | ||
==Disposition== | |||
*Often complex and should be based on presence/absence of acute complications | |||
*If no complications present, discussion with patient's primary care provider or gastroenterologist recommended | |||
==See Also== | |||
*[[Viral hepatitis]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:GI]] | |||
Revision as of 15:18, 26 June 2016
Background
- A generally irreversible fibrotic scaring of the liver parenchyma resulting in liver failure
- The twelfth leading cause of death in men and women in 2013.[1]
Clinical Features
| +1 | +2 | +3 | |
|---|---|---|---|
| Bilirubin | <2 mg/dL | 2-3 mg/dL | >3 Mg/dL |
| Albumin | >3.5 mg/dL | 2.8-3.5 mg/dL | <2.8 mg/dL |
| INR | <1.7 | 1.7-2.2 | >2.2 |
| Ascites | No ascites | Ascites, medically controlled | Ascites, poorly controlled |
| Encephalopathy | No encephalopathy | Encephalopathy, medically controlled | Encephalopathy, poorly controlled |
- Score ≤ 7 = Class A = 100% and 85% one and two-year patient survival
- Score 7 - 9 = Class B = 80% and 60% one and two-year patient survival
- Score ≥ 10 = Class c = 45% and 35% one and two-year patient survival
| MELD-Na Score | 3-month mortality |
|---|---|
| 40 | 71.3% |
| 30-39 | 52.6% |
| 20-29 | 19.6% |
| 10-19 | 6.0% |
| <9 | 1.9% |
Differential
- Hepatitis chronic B and C
- Alcoholic liver disease
- Non-alcoholic steatohepatitis
- Drug induced (ie. Tylenol. amiodarone, NRTIs])
- Cardiac Cirrhosis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Autoimmune Hepatitis
- Alpha1 anti-trypsin Deficiency
- Cystic Fibrosis
Management
Complications of cirrhosis
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Hepatocellular carcinoma
Disposition
- Often complex and should be based on presence/absence of acute complications
- If no complications present, discussion with patient's primary care provider or gastroenterologist recommended
See Also
External Links
References
- ↑ Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.
- ↑ Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64
- ↑ Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70.